Project Title: ?Differences in Inflammation, Cardiovascular Risk Factors and Respiratory Health with Use of Menthol Cigarettes: Informing the Regulation of Tobacco Flavorings to Protect Public Health? Abstract/Project Summary Despite smoking fewer cigarettes per day, Black men and women are at greater risk for some tobacco-related diseases including cardiovascular and respiratory diseases, compared to their white counterparts. The substantially higher prevalence of menthol cigarette use among Black smokers may contribute to these disparities. The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration Center for Tobacco Products (CTP) the authority to restrict the manufacture, sale and distribution of menthol cigarettes as appropriate to protect public health. An important part of the determination for the regulation of menthol cigarettes concerns the health effects of mentholated relative to nonmentholated cigarettes. Studies examining differences in health effects with menthol cigarette use have mainly focused on all-cause mortality and cancer outcomes, with few studies considering cardiovascular or pulmonary outcomes. There is limited information regarding potential differences in cardiovascular risk factors or respiratory health with menthol cigarette use and no studies have examined differences in inflammation comparing menthol and nonmenthol cigarette smokers. Therefore, the main objective of this project is to evaluate differences in systemic inflammation, cardiovascular risk factors and respiratory health with use of menthol cigarettes among smokers in the US. To meet this objective, we will leverage existing, publicly accessible interview, physical examination and biological specimen data from 9,880 adult current smokers who participated in the National Health and Nutrition Examination Survey (NHANES), a series of nationally-representative surveys of the US population, from 1999 through 2016. Multivariable adjusted linear and logistic regression models will be used to evaluate the associations between menthol compared to nonmenthol cigarette use with: (1) markers of systemic inflammation (C-reactive protein, fibrinogen, white blood cell count, and homocysteine); (2) cardiovascular risk factors (hypertension, diabetes, and reduced kidney function); and (3) respiratory health outcomes (fractional exhaled nitric oxide levels, spirometry-defined pulmonary impairment, past year wheeze, and frequent cough and frequent phlegm). This proposed research will provide needed information to guide the CTP determination regarding the banning of menthol cigarettes. Findings from this study will provide insight into differences in risk of tobacco-related diseases that could have implications for the regulation of menthol cigarettes in the US, including the potential health impacts to Black communities who are burdened by greater menthol cigarette advertising and promotion.